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VOLUME 25 , ISSUE 4 ( April, 2021 ) > List of Articles

PAEDIATRIC CRITICAL CARE

Tracheostomy before 14 Days: Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation?

Mihir Sarkar, Satyabrata Roychowdhoury, Subhajit Bhakta, Sumantra Raut, Mousumi Nandi

Keywords : Outcome, Pediatric intensive care, Tracheostomy,Mechanical ventilation

Citation Information : Sarkar M, Roychowdhoury S, Bhakta S, Raut S, Nandi M. Tracheostomy before 14 Days: Is It Associated with Better Outcomes in Pediatric Patients on Prolonged Mechanical Ventilation?. Indian J Crit Care Med 2021; 25 (4):435-440.

DOI: 10.5005/jp-journals-10071-23791

License: CC BY-NC 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: With the advancement of pediatric critical care services across India, many children require prolonged mechanical ventilation (MV), and tracheostomy is recommended to them. However, many pediatric intensivists have concerns regarding the safety, feasibility, and outcome of tracheostomy. We aimed to analyze clinical characteristics, indication, duration, and outcome of tracheostomized children with respect to timing of tracheostomy. Method: We conducted a retrospective study from the hospital clinical database of consecutive patients below 12 years who had undergone tracheostomy after admission into the pediatric intensive care unit (PICU) for prolonged ventilation (≥96 hours) from January 2015 to December 2019. The study was approved by the Institutional Ethics Committee. Patients were divided into two groups: tracheostomies done within 14 days of MV (early tracheostomy) and patients with tracheostomies performed after 14 days (late tracheostomy). Patients’ age, sex, indications, complications, decannulation rate, length of MV, PICU, and hospital stay were analyzed. Results: Of the 1,425 patients on invasive MV, 87 (6.1%) patients required tracheostomy after a mean 13.37 days of MV. The most common indication was encephalopathy 32 (36.7%) followed by acute respiratory distress syndrome 20 (22.9%). Factors like higher pediatric logistic organ dysfunction score, vasoactive inotrop score, incidence of pretracheostomy ventilator-associated pneumonia, and difficulty in obtaining parental consent were associated with late tracheostomy. The early tracheostomy group had a higher decannulation rate (odds ratio, 5.17; p, 0.01) and weaning rate (odds ratio, 5.94; p, 0.032). The late tracheostomy group needed a longer duration of MV, PICU, and hospital stay. Complications of tracheostomy were less in the early tracheostomy patients (odds ratio, 2.95; p, 0.03). Conclusion: Early tracheostomy was associated with lower complications, higher successful weaning rates, and less utilization of intensive care facilities in patients receiving prolonged MV. Clinical significance: In the context of scarcity of data on the timing of tracheostomy in children with prolonged ventilation (≥96 hours) the study shows that early (<14 days) tracheostomy is associated with a better outcome.


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  1. Payen V, Jouvet P, Lacroix J, Ducruet T, Gauvin F. Risk factors associated with increased length of mechanical ventilation in children. Pediatr Crit Care Med 2012;13(2):152–157. DOI: 10.1097/PCC.0b013e3182257a24.
  2. Holloway AJ, Spaeder MC, Basu S. Association of timing of tracheostomy on clinical outcomes in PICU patients. Pediatr Crit Care Med 2015;16(3):e52–e58. DOI: 10.1097/PCC.0000000000000336.
  3. Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child 2012;97(10):866–869. DOI: 10.1136/archdischild-2011-301494.
  4. Wakeham MK, Kuhn EM, Lee KJ, McCrory MC, Scanlon MC. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intens Care Med 2014;40(6):863–870. DOI: 10.1007/s00134-014-3298-4.
  5. Liu C, Heffernan C, Saluja S, Yuan J, Paine M, Oyemwense N, et al. Indications, hospital course, and complexity of patients undergoing tracheostomy at a tertiary care pediatric hospital. Otolaryngol Head Neck Surg 2014;151(2):232–239. DOI: 10.1177/0194599814531731.
  6. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med 2012;40(10):2890–2896. DOI: 10.1097/CCM.0b013e31825bc948.
  7. King C, Moores LK. Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med 2008;29(2):253–263. DOI: 10.1016/j.ccm.2008.01.002.
  8. Nseir S, Di Pompeo C, Jozefowicz E, Cavestri B, Brisson H, Nyunga M, et al. Relationship between tracheotomy and ventilator-associated pneumonia: a case control study. Eur Respir J 2007;30(2):314–320. DOI: 10.1183/09031936.06.00024906.
  9. Ishihara T, Tanaka H. Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis. Res Square 2020. DOI: 10.21203/rs.3.rs-19620/v1.
  10. Berry JG, Graham DA, Graham RJ, Zhou J, Putney HL, O’Brien JE, et al. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics 2009;124(2):563–572. DOI: 10.1542/peds.2008-3491.
  11. Andriolo BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015;1(1):Cd007271. DOI: 10.1002/14651858.CD007271.pub3.
  12. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 2010;303(15):1483–1489. DOI: 10.1001/jama.2010.447.
  13. Lin MC, Huang CC, Yang CT, Tsai YH, Tsao TC. Pulmonary mechanics in patients with prolonged mechanical ventilation requiring tracheostomy. Anaesth Intensive Care 1999;27(6):581–585. DOI: 10.1177/0310057X9902700604.
  14. Lesnik I, Rappaport W, Fulginiti J, Witzke D. The role of early tracheostomy in blunt, multiple organ trauma. Am Surg 1992;58(6):346–349. PMID: 1596033.
  15. Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 1990;108(4):655–659. PMID: 2218876.
  16. Blot F, Guiguet M, Antoun S, Leclercq B, Nitenberg G, Escudier B. Early tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study. Support Care Cancer 1995;3(5):291–296. DOI: 10.1007/BF00335304.
  17. Streitz Jr JM, Shapshay SM. Airway injury after tracheotomy and endotracheal intubation. Surg Clin North Am 1991;71(6):1211–1230. DOI: 10.1016/s0039-6109(16)45586-6.
  18. Ang AH, Chua DY, Pang KP, Tan HK. Pediatric tracheotomies in an Asian population: the Singapore experience. Otolaryngol Head Neck Surg 2005;133(2):246–250. DOI: 10.1016/j.otohns.2005.03.085.
  19. Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000;110(7):1099–1104. DOI: 10.1097/00005537-200007000-00006.
  20. Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H. Tracheostomy in young patients: indications and long-term outcome. Eur Arch Otorhinolaryngol 2009;266(5):705–711. DOI: 10.1007/s00405-008-0796-4.
  21. Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71(12):1829–1835. DOI: 10.1016/j.ijporl.2007.08.007.
  22. Leung R, Berkowitz RG. Decannulation and outcome following pediatric tracheostomy. Ann Otol Rhinol Laryngol 2005;114(10):743–748. DOI: 10.1177/000348940511401002.
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